RJ Henneberg, PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

RJ HENNEBERG, PLLC

Practice address

417 E Broadway Ave Ste 103
Moses Lake, WA 98837-3081

Phone

(509) 766-5015

Fax

(509) 855-9070

NPI assigned

Sep 1, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kasha Rapp

Title

Director of Operations

Phone

(509) 765-0150

Specialties & licenses 1

Addresses

Other names 1

• Sunrise Dental of Moses Lake Doing business as

Electronic endpoints 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Randal James Henneberg, D.D.S.

  • General Practice Dentistry
  • Spokane Valley, WA
  • NPI 1083846927
  NPD
• Nicholas Hampton Smith, DDS

  • General Practice Dentistry
  • Moses Lake, WA
  • NPI 1790355121
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1598918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598918400000",
    "number": "1700490356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "417 E BROADWAY AVE STE 103",
            "city": "MOSES LAKE",
            "state": "WA",
            "postal_code": "988373081",
            "telephone_number": "509-766-5015",
            "fax_number": "509-855-9070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "417 E BROADWAY AVE STE 103",
            "city": "MOSES LAKE",
            "state": "WA",
            "postal_code": "988373081",
            "telephone_number": "509-766-5015",
            "fax_number": "509-855-9070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RJ HENNEBERG, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-01",
        "last_updated": "2020-09-01",
        "certification_date": "2020-09-01",
        "status": "A",
        "authorized_official_last_name": "RAPP",
        "authorized_official_first_name": "KASHA",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "509-765-0150"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "moseslake@sunrisedental.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Email",
            "address_1": "417 E Broadway Ave Ste 103",
            "city": "Moses Lake",
            "state": "WA",
            "country_code": "US",
            "postal_code": "988373081",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Sunrise Dental of Moses Lake",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Philip Richins, MED LMHC
• Stacey D Rippy, SLP-A
• Ana Leticia Rivera
• Liliana Rivera
• Riverside Reflections
• Christopher Aaron Roberts
• Carry Joan Robey
• Mindy Robins
• Audrey Lovelle Robinson
• Melodie Rodeback, RN00052138

• General Practice Dentistry in Moses Lake, WA
• Providers in Moses Lake, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.